Doing time in Zambia's prisons may be a death sentence, regardless of the crime or conviction, as conditions behind bars drive high rates of HIV and tuberculosis (TB) says a new report.
The first independent review of correctional facilities by human rights organizations - Unjust and Unhealthy: HIV, TB and Abuse in Zambian Prisons - is based on interviews with staff and inmates at six of Zambia's 86 jails. Researchers found that poor conditions, overcrowding, and inadequate health services were driving up HIV and TB rates among inmates, who have scant access to care.
The report co-authored by the AIDS and Rights Alliance for Southern Africa (ARASA), and the Prisons Care and Counselling Association (PRISCCA), a Zambian prisoner rights organization, noted that about one-third of prison inmates were awaiting trial, pushing up the population in some prisons to more than five times their intended capacity.
Contrary to international norms, researchers found that there was no separation between awaiting-trial prisoners and convicted offenders, or between children and adults, increasing the potential for the sexual violence and exploitation often linked to HIV transmission in prisons. They also noted that the inadequate quality and quantity of food gave rise to transactional sex for food, and led to possible poor health among incarcerated mothers and their babies. Prevention of mother-to-child HIV transmission services were non-existent, as were gynaecological services such as screening for cervical cancer; HIV-positive women are thought to be at increased risk of this disease.
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According to UNAIDS, Zambia has a national HIV prevalence rate of about 15 percent, however the prevalence rate among prisoners has been estimated to be almost double that, according to a study published in the journal AIDS in 2001. TB, the leading infectious killer of people living with HIV worldwide, remains the leading cause of death in Zambian prisons where cells are often overcrowded, damp and poorly ventilated.
Despite high rates of both HIV and TB among prisoners, the Zambian Prison Services employed just 14 healthcare workers for a national population of 15,300 inmates as of October 2009. Interviewees told researchers that, given the lack of healthcare workers in prisons, it was up to untrained correctional officers to determine whether an inmate needed medical attention and that these officers often waited until it was too late.
Godfrey Malembeka, who spent four years in a Zambian prison before becoming executive director of PRISCCA, hoped the report would highlight the HIV-related needs of prisoners and men who have sex with men (MSM).
Malembeka told IRIN/PlusNews that there is a growing realization that MSMs and prisoners need targeted HIV programming and that research like this would only would bolster the argument for including these vulnerable groups in the new national strategic plan for HIV and AIDS currently being drafted.
Zambia's criminalization of same-sex practices, as in neighbouring Malawi, has led to a lack of HIV services for MSM, such as condom distribution, whether they are part of the prison population or not.
According to Malembeka, the Ministry of Home Affairs, which is responsible for Zambia's prison services, welcomed the report and said it wanted to work with human rights organizations like PRISCCA to explore the feasibility of implementing some of the report's recommendations.
Among the report’s suggestions were expanding parole eligibility to reduce overcrowding, condom distribution in prisons, and TB screening for inmates.